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Published on: September 26, 2018
Exploring a Need for a Cardiometabolic Disease Staging System as a Computerized Clinical Decision Support Tool:
Aizhan Karabukayeva1, Jami L Anderson1, Allyson G Hall1
1Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.
Insights
Primary care providers need better tools to manage cardiometabolic disease risk. A computerized decision support system (CDSS) with a cardiometabolic disease staging system (CMDS) can help identify and treat patients with obesity and diabetes.
Area of Science:
- Medical Informatics
- Primary Care Medicine
- Public Health
Background:
- Cardiometabolic diseases are major causes of illness and death in the U.S.
- Computerized tools for risk assessment are underutilized in primary care.
- Integrating cardiometabolic disease staging systems (CMDS) into computerized clinical decision support systems (CDSS) can improve patient identification and treatment.
Purpose of the Study:
- To explore current medical management of obesity.
- To assess the need for CMDS to aid in managing obesity and diabetes at the point of care.
Main Methods:
- Qualitative study using a general inductive approach.
- Semistructured, in-depth interviews with 10 primary care providers (PCPs).
- Interview protocol informed by literature on PCP experiences and need for management/prevention tools.
Main Results:
- PCPs prioritize behavioral treatments (diet, physical activity, behavior therapy) for overweight/obesity.
- Key CDSS features desired by PCPs include customizable support, comprehensive medical summaries, patient education resources, and ease of use.
Conclusions:
- A CMDS integrated into a CDSS can enhance PCPs' ability to assess cardiometabolic disease risk.
- This supports clinical management of overweight, obesity, and diabetes.
- Study findings offer insights for optimizing CDSS design, user experience, and adoption.
Background:
Although cardiometabolic diseases are leading causes of morbidity and mortality in the United States, computerized tools for risk assessment of cardiometabolic disease are rarely integral components of primary care practice. Embedding cardiometabolic disease staging systems (CMDS) into computerized clinical decision support systems (CDSS) may assist with identifying and treating patients at greatest risk for developing cardiometabolic disease.
Objective:
This study aimed to explore the current approach to medical management of obesity and the need for CMDS designed to aid medical management of people living with obesity, at risk of being obese, or diabetic at the point of care.
Methods:
Using a general inductive approach, this qualitative research study was guided by an interpretive epistemology. The method included semistructured, in-depth interviews with primary care providers (PCPs) from university-based community health clinics. The literature informed the interview protocol and included questions on PCPs' experiences and the need for a tool to improve their ability to manage and prevent complications from overweight and obesity.
Results:
PCPs (N=10) described their current approaches and emphasized behavioral treatments consisting of combined diet, physical activity, and behavior therapy as the first line of treatment for people who were overweight or obese. Results suggest that beneficial features of CDSS include (1) clinically relevant and customizable support, (2) provision of a comprehensive medical summary with trends, (3) availability of patient education materials and community resources, and (4) simplicity and ease of navigation.
Conclusions:
Implementation of a CMDS via a CDSS could enable PCPs to conduct comprehensive cardiometabolic disease risk assessments, supporting clinical management of overweight, obesity, and diabetes. Results from this study provide unique insights to developers and researchers by identifying areas for design optimization, improved end user experience, and successful adoption of the CDSS.
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